Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2013
Randomized Controlled Trial Multicenter Study Comparative StudyThe impact of bispectral index versus end-tidal anesthetic concentration-guided anesthesia on time to tracheal extubation in fast-track cardiac surgery.
Bispectral Index (BIS)-guided anesthesia administration has been reported to reduce the time to tracheal extubation. However, no trials have compared the ability of BIS guidance to promote earlier tracheal extubation relative to guidance by end-tidal anesthetic concentration (ETAC). We hypothesized that BIS-guided anesthesia would result in earlier tracheal extubation compared with ETAC-guided anesthesia in fast-track cardiac surgery patients. ⋯ Compared with management based on ETAC, anesthetic management based on BIS guidance does not strongly increase the probability of earlier tracheal extubation in patients undergoing fast-track cardiac surgery. The decision to extubate the trachea is more influenced by patient characteristics and perioperative course than the assignment to BIS or ETAC monitoring.
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Anesthesia and analgesia · Mar 2013
Randomized Controlled TrialResponse to succinylcholine in patients carrying the K-variant of the butyrylcholinesterase gene.
Succinylcholine is usually metabolized quickly by the butyrylcholinesterase enzyme (BChE) but genetic variants of BChE may prolong the duration of action. The Kalow (K) variant is the most common mutation in the butyrylcholinesterase gene (BCHE), being present in 25% of Caucasians. The significance of the K-variant for the duration of action of succinylcholine has not been well studied. Our hypothesis was that the duration of action of succinylcholine would be prolonged in patients heterozygous for the K-variant genotype compared with the normal genotype (wild-type). ⋯ We conclude that the mean duration of action of succinylcholine is prolonged for the patient heterozygous for the K-variant allele by at most 4 minutes relative to the wild-type, but this difference is small relative to the wide variability and overlap in recovery times among all patients.
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Anesthesia and analgesia · Mar 2013
Randomized Controlled TrialUnwarranted variability in antibiotic prophylaxis for cesarean section delivery: a national survey of anesthesiologists.
Current guidelines from the American College of Obstetricians and Gynecologists recommend antibiotic prophylaxis for cesarean delivery immediately before incision. The purpose of this study was to measure and describe correlates of adherence to these guidelines in a sample of United States anesthesiologists. ⋯ Adherence with current prophylactic antibiotic administration guidelines for cesarean delivery is not uniform. Education initiatives, regulatory maneuvers, and process improvement should be targeted at sites where anesthesiologists do not comply with current guidelines.
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Anesthesia and analgesia · Mar 2013
The effects of anesthetics on chronic pain after breast cancer surgery.
The incidence and predictive factors for chronic pain after breast cancer surgery have been widely studied. Because it negatively affects patients' daily lives, methods to prevent and reduce chronic pain and its severity should be developed. Our previous study showed that propofol anesthesia has an antihyperalgesic effect under remifentanil-induced hyperalgesia and reduced acute pain compared with sevoflurane anesthesia. In this study, we investigated the hypothesis that propofol would prevent the development and severity of chronic pain after breast cancer surgery, as in acute pain. ⋯ This study showed that propofol anesthesia was associated with a lower incidence of chronic pain after breast cancer surgery than sevoflurane anesthesia. However, propofol did not have a significant effect on severity and duration of chronic pain. Further prospective studies are needed to confirm the validity of these provocative findings.